Cerebral Microsporidiosis Due toEncephalitozoon cuniculi

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Abstract
The magnetic resonance imaging (MRI) scan shown in Figure 1 of the report by Weber et al. (Feb. 13 issue)1 shows congestion of the ethmoid sinus, not the right maxillary sinus, as the figure legend says. The scan does not show the maxillary sinuses. It is not permissible to diagnose sinusitis only on the basis of an MRI scan, because MRI often demonstrates mucosal thickening without clinical disease.2 Was there a rhinoscopic examination? The authors relate the observed sinus congestion to the Encephalitozoon cuniculi infection. Chronic sinusitis is very common in patients with human immunodeficiency virus (HIV) infection, and the traditional sinus pathogens are usually responsible for the infection.3 Did the authors perform a sinusal lavage to isolate the pathogen? As they observe, detecting E. cuniculi may be difficult in the cerebrospinal fluid or the urinary sediment.